The spouse of a patient who experiences delusions asks the nurse, “Are there any circumstances under which the treatment team is justified in violating the patient’s right to confidentiality?” What is the nurse’s best response?

“We are not bound if the patient threatens the life of another person.”

“We can’t violate that confidence under any circumstances.”

“We are obligated to answer questions asked by law enforcement.”

“We can do that only at the discretion of the psychiatrist.”

Answer and Explanation

The Correct Answer is A

Choice A reason: Confidentiality can be breached if a patient poses a threat to others, as in Tarasoff rulings, due to safety risks from delusions driven by dopamine dysregulation. This legal and ethical exception ensures protection, aligning with psychiatric principles prioritizing harm prevention over absolute confidentiality.

Choice B reason: Absolute confidentiality is incorrect, as exceptions exist for safety. Delusions, linked to mesolimbic dopamine excess, may lead to threats requiring disclosure. Legal frameworks allow breaching confidentiality to protect others, making this response scientifically and ethically inaccurate for psychiatric practice.

Choice C reason: Law enforcement inquiries do not automatically override confidentiality. Disclosure is limited to specific legal mandates, like imminent danger from dopamine-driven delusions. Routine questions do not justify breaches, making this response incorrect for the ethical and legal standards in psychiatric care.

Choice D reason: Confidentiality breaches are not solely at the psychiatrist’s discretion. Legal and ethical guidelines, like those for threats from delusional states, dictate exceptions. This option oversimplifies complex regulations, ignoring standardized protocols for managing risks in psychiatric patients, making it incorrect.

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Correct Answer is C

Explanation

Choice A reason: Projection involves attributing one’s issues to others, not ignoring symptoms. The patient’s dismissal of serious symptoms, like weight loss, suggests denial, not projection. These symptoms may indicate physiological issues, not psychological attribution, making projection incorrect for this defense mechanism.

Choice B reason: Regression involves reverting to childish behaviors, not ignoring symptoms. The patient’s claim of a minor cold despite weight loss and fatigue reflects denial, not regression. These symptoms suggest a serious condition, not immature coping, making this an incorrect defense mechanism.

Choice C reason: Denial involves refusing to acknowledge serious symptoms, like weight loss and fatigue, which may indicate a medical condition. By attributing them to a minor cold, the patient avoids reality, a common defense in stress-related cortisol spikes, making this the correct mechanism.

Choice D reason: Displacement redirects emotions to another target, not ignoring symptoms. The patient’s minimization of serious health issues, like fatigue, reflects denial, not redirected feelings. This mechanism is unrelated to dismissing physical symptoms, making it incorrect for the described behavior.

A. Remain silent and add the suggested outcome to the plan B. Formulate a more appropriate outcome without the patient’s input C. Explore with the patient possible consequences of the outcome D. Educate the patient that the outcome is not realistic

Correct Answer is C

Explanation

Choice A reason: Silently adding an inappropriate outcome disregards patient safety and autonomy. Outcomes must align with neurobiological needs, like serotonin modulation for depression. This approach fails to engage the patient in decision-making, risking ineffective treatment and neglecting evidence-based collaborative care principles.

Choice B reason: Formulating outcomes without patient input violates autonomy. Collaborative goal-setting, considering neurobiological factors like dopamine imbalances, ensures patient engagement and effective treatment. Excluding the patient disregards their perspective, reducing adherence and therapeutic alliance, making this approach contrary to evidence-based psychiatric nursing.

Choice C reason: Exploring consequences respects autonomy while guiding patients toward safe outcomes. Discussing implications, like medication non-adherence worsening dopamine-driven symptoms, fosters informed decisions. This collaborative approach aligns with cognitive-behavioral principles and neurobiological treatment needs, ensuring effective, patient-centered care in psychiatric practice.

Choice D reason: Educating that an outcome is unrealistic may dismiss patient autonomy. While addressing neurobiological realities, like serotonin deficits, is important, unilateral education risks disengagement. Collaborative exploration of consequences is more effective, promoting informed choices and adherence, making this option less suitable than discussion.

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The spouse of a patient who experiences delusions asks the nurse, “Are there any circumstances under which the treatment team is justified in violating the patient’s right to confidentiality?” What is the nurse’s best response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is undergoing diagnostic tests. The patient says, “Nothing is wrong with me except a stubborn chest cold.” The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?

Correct Answer is C

Explanation

A nurse works with a patient to establish goals/outcomes. The nurse believes that one outcome suggested by the patient is not in the patient’s best interest. What is the nurse’s best action?

Correct Answer is C

Explanation

A client experiences panic attacks when confronted with riding in elevators. The nurse is teaching the client to use relaxation techniques while gradually exposing the client to getting on an elevator. Which technique is the nurse using?

A nurse uses Maslow’s hierarchy of needs to plan care for a psychotic patient. Which problem will receive priority?

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The nursing student understands that the purpose of completing a process recording for the nurse-patient interview is to:

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

A nurse caring for a withdrawn, suspicious patient recognizes the development of feelings of anger toward the patient. What is the nurse’s best response to these feelings?

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On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to do what?